Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.
Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
Eur J Intern Med. 2018 Jun;52:40-48. doi: 10.1016/j.ejim.2018.01.033. Epub 2018 Feb 4.
Echocardiography plays an important role in infective endocarditis (IE) diagnosis according with the modified Duke criteria. We evaluated the implications of a positive echocardiography in the prognosis of a cohort of patients with IE.
Prospective multicentre study in 31 Spanish centres. From January 2008 to September 2016, 3467 patients were included (2765 definite IE, 702 possible IE). The main outcome was in-hospital mortality. Echocardiography diagnosis was based on modified Duke criteria for the diagnosis of IE.
Median age was 69 years (interquartile range: 57-77 years). Comorbidity was high (mean Charlson index 4.7 ± 2.8). Transoesophageal echocardiography was performed in 2680 (77.3%). The overall inhospital mortality rate was 26.7%. Univariate analysis showed that, in patients with definite IE, inhospital mortality was similar in patients with positive and negative echocardiography (27.7% vs. 24.6%, respectively, p = 0.121). In possible IE these figures were 27.5% vs. 16.7%, respectively, p < 0.001. Complications (cardiac and extracardiac [embolic, immunological, and septic shock]) were more frequent with positive than with negative echocardiography, regardless of clinical suspicion (definite IE 35.5% vs. 16.8%, respectively, p < 0.001; possible IE 20.8% vs. 7.6%, respectively, p < 0.001). Positive echocardiography was a predictor of inhospital death by logistic regression modelling, after adjusting for confounders, definite IE (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.02-1.76, p = 0.036), possible IE (OR 1.59, 95% CI 1.02-2.45, p = 0.036).
A positive echocardiography in patients with IE is associated with increased inhospital mortality, in addition to other clinical factors and comorbidities.
根据改良的杜克标准，超声心动图在感染性心内膜炎（IE）诊断中发挥着重要作用。我们评估了阳性超声心动图对IE 患者队列预后的影响。
这是一项在西班牙 31 个中心开展的前瞻性多中心研究。2008 年 1 月至 2016 年 9 月，共纳入 3467 例患者（2765 例明确 IE，702 例可能 IE）。主要结局为住院死亡率。超声心动图诊断基于改良的杜克标准诊断 IE。
中位年龄为 69 岁（四分位距：57-77 岁）。合并症发生率高（平均 Charlson 指数 4.7±2.8）。2680 例患者（77.3%）进行了经食管超声心动图检查。总的院内死亡率为 26.7%。单因素分析显示，在明确 IE 患者中，阳性和阴性超声心动图患者的院内死亡率相似（分别为 27.7%和 24.6%，p=0.121）。在可能 IE 中，这两个数字分别为 27.5%和 16.7%，p<0.001。无论临床怀疑程度如何，阳性超声心动图与阴性超声心动图相比，心脏和心脏外并发症（栓塞、免疫和感染性休克）更常见（明确 IE 分别为 35.5%和 16.8%，p<0.001；可能 IE 分别为 20.8%和 7.6%，p<0.001）。在校正混杂因素后，通过逻辑回归模型，阳性超声心动图是住院死亡的预测因素，在明确 IE（比值比 [OR] 1.3，95%置信区间 [CI] 1.02-1.76，p=0.036）和可能 IE（OR 1.59，95% CI 1.02-2.45，p=0.036）中均如此。
IE 患者阳性超声心动图与住院死亡率增加相关，除其他临床因素和合并症外。
